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Tags: gynecology, Infectious Diseases, Urology

Show Notes

Table of Contents

(1:49 ) Chlamydia 

(3:31 ) Gonorrhea

(4:50 ) PID

(6:14 ) Syphilis

(8:08 ) Neurosyphilis 

(9:13 ) Tertiary Syphilis

(10:06 ) Trichomoniasis 

(11:13 ) Herpes

(12:49 ) HIV

(14:10 ) PEP

(15:13 ) Mycoplasma Genitalium 

(18:00 ) Take Home Points

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Chlamydia:

• Prevalence:

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    • Most common STI.
    
    
    • High percentage of asymptomatic cases (40% to 96%).
    
    
    
    
  
  
  
  

• Presentation:

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    • Urethritis, cervicitis, pelvic inflammatory disease (PID), prostatitis, proctitis, pharyngitis, arthritis.
    
    
    • Importance of considering extra-genital sites (oral and rectal infections).
    
    
    
    
  
  
  
  

• Testing:

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    • Gold Standard: Nucleic Acid Amplification Test (NAAT) via PCR.
    
    
    
    
  
  
  
  

• Sampling Sites:

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      • Endocervical or urethral swabs preferred over urine samples due to higher sensitivity.
      
      
      • Triple-site testing (genital, rectal, pharyngeal) recommended for comprehensive detection.
      
      
      
      
    
    
    
    
  
  
  
  

• Treatment Updates:

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    • Previous Regimen: Azithromycin 1 g orally in a single dose.
    
    
    • Current First-Line Treatment: Doxycycline 100 mg orally twice daily for 7 days.
    
    
    
    
  
  
  
  

• Alternatives:

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  • 
    
    
    
    • Azithromycin remains an option for patients unlikely to adhere to a 7-day regimen or for pregnant patients.
    
    
    
    
  
  
  • Note: PID treatment differs and will be discussed separately.
  
  
  
  

Gonorrhea:

• Presentation:

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  • 
    
    
    
    • Similar to chlamydia; can be asymptomatic.
    
    
    • Symptoms include urethritis, cervicitis, PID, prostatitis, proctitis, pharyngitis.
    
    
    
    
  
  
  
  

• Testing:

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  • 
    
    
    
    • Gold Standard: NAAT.
    
    
    
    
  
  
  
  

• Sampling Sites:

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  • 
    
    
    
    • 
      
      
      
      • Endocervical swabs are more sensitive than urine samples.
      
      
      • Triple-site testing is crucial to avoid missing infections.
      
      
      
      
    
    
    
    
  
  
  
  

• Treatment Updates:

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  • 
    
    
    
    • Previous Regimen: Ceftriaxone 250 mg IM plus azithromycin 1 g orally.
    
    
    • Current Recommendation: Ceftriaxone 500 mg IM single dose.
      
      
      
      • Adjusted due to rising azithromycin resistance and updated pharmacokinetic data.
      
      
      
      
    
    
    
    
  
  
  
  

• Co-Infection Considerations:

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  • High rates of chlamydia and gonorrhea co-infection (20% to 40%).
  
  
  • CDC recommends empiric treatment for chlamydia when treating gonorrhea to prevent complications like PID and infertility.
  
  
  
  

Pelvic Inflammatory Disease (PID):

• Etiology:

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  • 
    
    
    
    • Not solely caused by chlamydia and gonorrhea; about 50% of cases involve other pathogens like bacterial vaginosis (BV) organisms and anaerobes.
    
    
    
    
  
  
  
  

• Treatment Changes:

• Expanded Coverage Regimen:

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  • 
    
    
    
    • Ceftriaxone 500 mg IM once.
    
    
    • Doxycycline 100 mg orally twice daily for 14 days.
    
    
    • Metronidazole 500 mg orally twice daily for 14 days.
    
    
    
    
  
  
  • Inclusion of metronidazole addresses anaerobic bacteria contributing to PID.
  
  
  
  

Syphilis:

• Stages and Presentation:

• Primary Syphilis:

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    • Painless chancre on genitals.
    
    
    • Treatment: Penicillin G 2.4 million units IM single dose.
    
    
    
    
  
  
  
  

• Secondary Syphilis:

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    • Rash (often diffuse), mucocutaneous lesions, nonspecific joint pain.
    
    
    • Treatment: Same as primary syphilis.
    
    
    
    
  
  
  
  

• Latent Syphilis:

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    • Asymptomatic phase; divided into early (<1 year) and late (>1 year).
    
    
    
    
  
  
  
  

• Treatment for Late Latent:

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  • Penicillin G 2.4 million units IM once weekly for 3 weeks.
  
  
  • Recommended when the timing of infection is unclear.
  
  
  
  

Neurosyphilis:

• Can occur at any stage.


• Symptoms include visual changes, severe headaches, neurological deficits.

• Diagnosis: Requires lumbar puncture (LP) for confirmation.


• Treatment: Admission for intravenous penicillin G.

Tertiary Syphilis:

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